Factors Associated with Visual Inspection Acetic Acid Examination at the Independent Medical Center of Doctor Aloysius 1st Elvine Ivana Kabuhung, 2nd H. Ali Rakhman Hakim {[email protected] 1, [email protected] 2} Sari Mulia University, Banjarmasin Abstract. Cervical cancer is the second highest reproductive organ disease in Indonesia with a prevalence of 0.8% in 2013. Early detection of cervical cancer is checked the method of Inspection Visual Acetic Acid (IVA) examination. IVA examination is an inexpensive and practical detection method. Data from the Central Kalimantan Provincial Health Office states that in 2014 and 2015 the achievement of IVA examinations was only 0.3% and 1%. This study aims to analyze the factors associated with IVA examination using the Chi Square statistical test on 30 respondents with purposive sampling technique at the Independent Medical Center (IMC) of Doktor Aloysius. The results showed that the factors of attitudes, education, health insurance, and husband's support had a p value respectively were OR 0.003; 0.548; 0.712; 0.045; 95% CI. Based on these results was concluded that the factors of women's attitudes and husband's support are related to IVA examinations while the education and health insurance factors are not related to IVA examinations. Keywords: Cervical Cancer, Acetic Acid Visual Inspection Examination, Attitude, Husband Support, Education, Health Insurance. 1. Introduction Cervical cancer is a disease of the female reproductive organs with the second- highest number of cases in women. The prevalence of cervical cancer in 2013 was around 0.8% [1]. Cervical cancer is commonly found in developing countries, such as Indonesia. Cervical cancer is a significant problem in developing countries, where around 80% of cervical cancer cases occur each year. Cervical cancer ranks second out of all the number of cancers in women in Indonesia. Every year, more than 460,000 cases occur and around 231,000 women die from the disease [2,3]. Cervical cancer detected early using the Inspection Visual Acetic Acid (IVA) method. IVA examination is very easy to do, inexpensive, require a short time and NS-UNISM 2019, November 23, Banjarmasin, Indonesia Copyright © 2020 EAI DOI 10.4108/eai.23-11-2019.2298414 the results of the examination are immediately known. Even with all these advantages it is not easy to increase the achievement of targets for IVA examination in women. The Central Kalimantan Provincial Health Office recorded data from 7 cities / regencies (Palangka Raya City, Kotawaringin Timur Regency, Seruyan Regency, Katingan Regency, Pulang Pisau Regency, Kapuas Regency, and Murung Raya Regency) for 4 consecutive years. There were 827 women who had undertaken IVA examinations in 2014 out of 258,984 people (0.3%) and in 2015 there were 1679 people out of 217,577 people (1%). In 2016, IVA examinations are targeted to reach 20% of 330,861 women spread across 13 districts and 1 city in Central Kalimantan and in 2017 it is targeted to be 30% of 99,258 women, but the data for January 2017 to March 2017 results from IVA examinations in Central Kalimantan reached by 4.42%. [4,5] In an effort to improve the achievement of IVA examination targets in each district / city in Central Kalimantan, the Health Office trains health workers in each district / city to be able to conduct IVA examinations. One of the trained health workers was dr. Aloysius Yuwono Suprapta, who was directed directly by the South Barito District Health Office to attend the IVA examination training. Doctor Aloysius's Independent Medical Center (IMC) serves IVA examinations with the services of the Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan. Data from IMC Doctor Aloysius found that IVA examination outcomes were still low, namely 2 people in 2016 and 12 people in 2017 from January to August. Although socialization has been done about the importance of IVA examinations and IVA examination schedules, some women said they were embarrassed to do IVA examinations, some said they were worried about the high costs, some even said they had to consult their husbands first. [5] 2. Research Methods This research uses analytic survey method with cross sectional design. The sample used as many as 30 people with a purposive sampling technique and analysis using the Chi-Square statistical test. The selected respondents were women who were eligible for an IVA examination. The study was conducted every Wednesday according to the schedule of IVA examination services at IMC Doctor Aloysius. 3. Results 3.1 Univariate Analysis a. IVA Examination Table 1. Frequency distribution of respondents based on IVA examination IVA f % Examination Are not do 12 40 Do 18 60 Amount 30 100 Table 1 were explained that 60% of respondents underwent IVA examination. b. Attitude Table 2. Frequency distribution of respondents based on attitude Attitude f % Negative 8 26,7 Positive 22 73,3 Amount 30 100 Table 2 were explained that 73.3% of respondents have a positive attitude towards IVA examination c. Education Table 3. Frequency distribution of respondents based on education Education f % High 27 90 Low 3 10 Amount 30 100 Table 3 were explained that 90% of respondents have a high level of education d. Health Insurance Table 4. Frequency distribution of respondents based on health insurance Health f % Insurance Do not have 11 36,7 Have 19 63,3 Amount 30 100 Table 4 were explained that 63.3% of respondents have health insurance. e. Husband's Support Tabel 5. Frequency distribution of respondents based on husband's support Husband's f % Support Does not support 10 33,3 Support 20 66,7 Amount 30 100 Table 5 were explained that 66.7% of respondents received husband's support for conducting an IVA examination. 3.2 Bivariate Analysis a. Correlation of Attitude with IVA Examination Table 6. Cross table of attitude with IVA examination IVA examination Total Attitude No Yes f % f % n % P Value = Negative 7 23,3 1 3,3 8 26,7 0,003 Positive 5 16,7 17 56,7 22 73,3 Amount 12 40 18 60 30 100 Statistical test results between attitude and IVA examination obtained p value = 0,003 means that it has correlation between attitude and IVA examination. b. Correlation of Education with IVA Examination Table 7. Cross table of education with IVA examination IVA examination Total Education No Yes f % f % n % P Value = Low 2 6,7 1 3,3 3 10 0,548 High 10 33,3 17 56,7 27 90 Amount 12 40 18 60 30 100 Statistical test results between education and IVA examination p value = 0,548 means that were no correlation between education and IVA examination. c. Correlation of Health Insurance with IVA Examination Table 8. Cross table of health insurance with IVA examination IVA examination Health Total Insurance No Yes f % f % n % P Value = No 5 16,7 6 20 11 36,7 0,712 Yes 7 23,3 12 40 19 63,3 Amount 12 40 18 60 30 100 Statistical test results between health insurance ownership and IVA examination obtained p value = 0,712 means that were no correlation between health insurance ownership and IVA examination. d. Correlation between Husband's Support with IVA Examination Table 9. Cross table of husband's support with IVA examination IVA examination Husband's Total Support No Yes f % f % n % P Value = No 7 23,3 3 10 10 33,3 0,045 Yes 5 16,7 15 50 20 66,7 Amount 12 40 18 60 30 100 Statistical test results between IVA examination with husband support obtained p value = 0,045 meaning that it has correlation between IVA examination and husband support. 4. Discussion 4.1 Relationship of Attitude and IVA Examination A positive attitude is an attitude that shows or shows, accepts, acknowledges, and approves the norms that apply where the individual is located, in this case IVA examination. The results of this study indicate there is a relationship between attitude and IVA examination. If someone behaves that cervical cancer does not cause a negative impact on themselves and their families then it does not trigger the person's awareness to do early detection of cervical cancer [6]. Factors that cause mothers not to undergo IVA examination include the presence of unfavorable attitudes such as embarrassment to have a check-up, feel no need to check themselves and feel the IVA test is not important. This is consistent with the theory that attitudes are formed by the interaction experienced by individuals. This interaction contains a deeper meaning so that there is a relationship that affects each other between individuals, also with the physical environment and the surrounding psychological environment [7]. 4.2 Relationship of Education with IVA Examination High School and Higher Education is a tertiary level of education. Higher education is education that prepares students to become members of society who have academic and professional skills so that they can apply, develop and / or create science, technology, and art in the framework of national development and improve human welfare [8]. The results showed that there was no relationship between education and IVA examination. This study is in line with the results of research conducted by Istiqomah Risa, namely there is no significant relationship between maternal education and IVA examination participation [9]. Higher education makes it easier for someone to get information from print, electronic, health workers, family and friends. High school education includes high school level so that one will be easy to obtain information including information about health that gives effect to people's attitudes and practices in maintaining and improving their own health. Kurniawati explained in her study that women with low levels of education did not get enough information about the early detection of cervical cancer.